Error training: Missing link in surgical education

Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. .
Surgery (Impact Factor: 3.38). 11/2011; 151(2):139-45. DOI: 10.1016/j.surg.2011.08.008
Source: PubMed


PEOPLE MAKE MISTAKES. Human error is inevitable and must be anticipated, especially in environ-ments where novices are developing new knowl-edge and skills. 1 In medical education, faculty members are charged with supervising their resi-dents to minimize chances of patient care errors. This is no small challenge for faculty given the con-sequences of errors to patients, the psychological cost to learners, and the ramifications for the fac-ulty member and hospital from the fiscal, resource, and medicolegal perspectives. Yet, if decision-making and technical errors are bound to occur during a physician's career because of human in-fallibility, and residents have uneven and limited exposure to errors because of responsible faculty oversight, how will they graduate fully prepared to recognize and manage an error when one does occur? Satava 2 explained that faculty mem-bers spend so much time teaching residents how to do the correct thing that they forget to explicitly teach how to avoid errors or fix it when one has oc-curred. Residents encounter errors during their residency but this ''catch as catch can'' strategy can-not provide a sufficient and balanced array of op-portunities to hone the perceptual, cognitive, and technical skills needed to prevent, recognize, or manage the range of potential errors. 3 The purpose of this paper is to: (1) justify the importance of integrating planned instruction about errors into surgical residency curricula despite reduced work hours and an already over-crowded residency curricula; (2) discuss the scope of what could be taught to residents about errors; (3) describe instructional models and strategies for teaching error prevention, recognition, and man-agement strategies; and (4) suggest areas for future research and development to strengthen this aspect of clinical education that bears such critical implications for patient safety.

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Available from: Debra A Darosa, Jan 19, 2016
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    • "The concepts of vicarious error management training (EMT) and error-based learning provide an additional avenue in the effective training of novice learners[7]. EMT allows interns to gain insight through open discussion of common errors, focusing on how to avoid them and the subsequent management of their consequences[7]. An emphasis on discussing common errors allows interns to become more adept at correcting them and ultimately provides the emotional stability to adjust their management when errors are made in the clinical setting[8]. "

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    ABSTRACT: Research suggests a benefit from a skills curriculum emphasizing error prevention, identification, and management. Our purpose was to identify common errors committed by trainees during simulated thoracoscopic lobectomy for use in developing an error-based curriculum. Twenty-one residents (postgraduate years 1 to 8) performed a thoracoscopic left upper lobectomy on a previously validated simulator. Videos of the procedure were reviewed in a blinded fashion using a checklist listing 66 possible cognitive and technical errors. Of the 21 residents, 15 (71%) self-reported completing the anatomic lobectomy; however, only 7 (33%) had actually divided all of the necessary structures correctly. While dissecting the superior pulmonary vein, 16 residents (76%) made at least one error. The most common (n=13, 62%) was dissecting individual branches rather than the entire vein. On the bronchus, 14 (67%) made at least one error. Again, the most common (n=9, 43%) was dissecting branches. During these tasks, cognitive errors were more common than technical errors. While dissecting arterial branches, 18 residents (86%) made at least one error. Technical and cognitive errors occurred with equal frequency during arterial dissection. The most common arterial error was excess tension on the vessel (n=10, 48%). Curriculum developers should identify skill-specific technical and judgment errors to verify the scope of errors typically committed. For a thoracoscopic lobectomy curriculum, emphasis should be placed on correct identification of anatomic landmarks during dissection of the vein and airway and on proper tissue handling technique during arterial dissection.
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    ABSTRACT: Background: Technical errors, a distinct subcomponent of surgical proficiency, have a significant impact on patient safety and clinical outcomes. To date, only a few studies have been designed to describe and evaluate these errors. This review was performed to assess technical errors described in laparoscopic surgery. Methods: A literature search of Medline, Cochrane, EMBASE, and OVID databases (1946-2012, week 14) using the terms "technical/medical error," "technical skill," and "adverse event" in combination with the terms "laparoscopy/laparoscopic surgery" was conducted. English language peer review articles with a description of technical errors were included. Opinion papers, reviews, and articles not addressing laparoscopic surgery were excluded. Results: The search returned 2,282 articles. Application of the inclusion criteria reduced the number of articles to 21. Of these 21 articles, 14 (67 %) were observational studies, 3 (14 %) were randomized trials, 2 (10 %) were prospective interventional studies, and 2 (10 %) were retrospective analyses. Eight articles (38 %) applied error analysis as an approach to determine error rates within routine procedures. The remaining 13 articles (62 %) used the assessment of errors to describe and quantify surgical skill in an educational setting. Conclusions: A number of approaches for the assessment of surgical technical errors exist. The error definitions vary greatly, making a comparison of error rates between groups impossible. Complexity of scale design and subjectivity in ratings have resulted in limited use of these scores outside the experimental setting. To facilitate error analysis as a self-assessment method of continuous learning and quality control, further research and better tools are required.
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